title: Vasculitis mimics: cocaine-induced midline destructive lesions.
abstract: It has been recognized that nasal cocaine abuse can induce midline destructive lesions that can mimic different disorders, including small-vessel vasculitis. The authors reported 2 cases of patients referred to the rheumatology clinic with a previous diagnosis of granulomatosis with polyangiitis (Wegener's granulomatosis), presenting with chronic perforation in the palate, refractory to immunosuppressant therapy. In both patients, laboratory investigation revealed antineutrophil cytoplasmic antibody positivity. A differential diagnosis between cocaine-induced midline destructive lesions and granulomatosis with polyangiitis is also difficult to establish because of the presence of antineutrophil cytoplasmic antibody in both disorders. Given the high prevalence of cocaine use, awareness of this mimic is essential to avoid a misdiagnosis and the use of unnecessary and potential toxic therapies.
authors.affiliation: Department of Internal Medicine, Section of Rheumatology, LSU Health Sciences, New Orleans, Louisiana.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Perez Alamino
authors.forename: Luis R
authors.initials: LR
authors.lastname: Espinoza
mesh_terms: D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D003042:Cocaine / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000627:therapeutic use; D003937:Diagnosis, Differential; D014890:Granulomatosis with Polyangiitis / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010159:Palate / Q000473:pathology; D011241:Prednisone / Q000627:therapeutic use; D017211:Treatment Failure; D014657:Vasculitis / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D003042:Cocaine; D011241:Prednisone